Tympanic Membrane Pictures, Function & Anatomy | Body Maps Your message has been sent. OK We're sorry, an error occurred. We are unable to collect your feedback at this time. However, your feedback is important to us. Please try again later. Close Tympanic membrane The tympanic membrane is a vital component of the human ear, and is more commonly known as the eardrum. It is a thin, circular layer of tissue that marks the point between the middle ear and the external ear. It is approximately 0.1 mm thick, 8 to 10 mm in diameter, and has a mass weight of around 14 mg. Despite this diminutive size and mass, the tympanic membrane is extremely tough and flexible, and difficult to damage beyond repair. The tympanic membrane is comprised of three layers of tissue: the outer cutaneous layer, the fibrous middle layer, and a layer of mucous membrane on its innermost surface. The membrane is held in place by a thick ring of cartilage, a tough but flexible kind of tissue. The tympanic membrane's function is to assist in human hearing. When sound waves enter the ear, they strike the tympanic membrane.

The membrane vibrates with the force of the sound wave strike and transmits the vibrations further in, to the bones of the middle ear. Patients with ruptured or absent tympanic membranes have extreme difficulty in hearing, and possibly even complete hearing loss. Tympanic Membrane | Definition of Tympanic Membrane by Merriam-Webster noun Medical Definition of tympanic membrane : a thin membrane separating the middle ear from the inner part of the external auditory canal that vibrates in response to sound energy and transmits the resulting mechanical vibrations to the structures of the middle ear—called also eardrum, tympanum Illustration of tympanic membrane Tympanic membrane: MedlinePlus Medical Encyclopedia Image URL of this page: //medlineplus.gov/ency/imagepages/8993.htm Tympanic membrane Overview The tympanic membrane is also called the eardrum. It separates the outer ear from the middle ear. When soundwaves reach the tympanic membrane they cause it to vibrate. The vibrations are then transferred to the tiny bones in the middle ear. The middle ear bones then transfer the vibrating signals to the inner ear.

The tympanic membrane is made up of a thin connective tissue membrane covered by skin on the outside and mucosa on the internal surface. Review Date 5/25/2016 Updated by: Sumana Jothi, MD, specialist in laryngology, Assistant Clinical Professor, UCSF Otolaryngology, NCHCS VA, SFVA, San Francisco, CA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team. A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission ( URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy , editorial process and privacy policy . A.D.A.M.

is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation ( The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 1997-2017, A.D.A.M., Inc. Duplication for commercial use must be authorized in writing by ADAM Health Solutions. Holding Child for Examination of the Ear Patient 2, Left ear This child has bulging acute otitis media, with erythema, and opacification. The light reflex is absent. No normal structures can be visualized. The tympanogram was type “A prime”, which means that the tympanic membrane is not retracted and is still somewhat mobile. Patient 3, Left ear This child has opaque, milky appearing fluid behind the tympanic membrane. This is an example of otitis media with effusion. The child does not have acute otitis media.

The tympanogram was classified as type “A”, which means that, despite the effusion, the tympanic membrane was still mobile. Myringitis (Middle Ear, Tympanic Membrane, Inflammation): Background, Pathophysiology, Epidemiology Myringitis (Middle Ear, Tympanic Membrane, Inflammation) Updated: Dec 07, 2016 Author: John Schweinfurth, MD; Chief Editor: Arlen D Meyers, MD, MBA more... Share Overview Background The extremely thin and delicate tympanic membrane (TM) is the first component of the middle ear conductive system. The TM is easily traumatized, and diseases of the TM deprive patients of their ability to work and to enjoy life. Myringitis, or inflammation of the TM, may be accompanied by hearing impairment and a sensation of congestion and earache. After 3 weeks, acute myringitis becomes subacute and, within 3 months, chronic. The TM lies across the end of the external auditory canal (EAC) and looks like a flattened cone with its apex pointed inward as seen in the image below. The diameter of the TM is about 8-10 millimeters.

Its outer surface is slightly concave. Tympanic membrane (TM) as continuation of the upper wall of external auditory canal (EAC) with angle of incline up to 45 degrees on the border between middle ear and the EAC. View Media Gallery The edge of the membrane is thickened and attached to a groove in an incomplete ring of bone, the tympanic annulus, which almost encircles it and holds the membrane in place as seen in the image below. Normal tympanic membrane. Pars tensa (PT), pars flaccida (PF), light reflex (LR), fibrous ring (FR), umbo (Um), handle of malleus (HM), lateral process of malleus (Lpm), anterior plica (AP), posterior plica (PP). View Media Gallery In newborns, the angle of incline of the TM is more than 30° relative to the horizontal plane. In addition, the TM in newborns is thicker than in adults; consequently, in the newborn, examining the TM is sometimes difficult. The uppermost small area of the membrane, where the ring is open, is under no tension; this part is known as the pars flaccida.

The majority of the membrane is tightly stretched; this is called the pars tensa. The loose part of the TM, or the pars flaccida, borders on the pars tensa from above and is considerably smaller, about one-eighth the size of the pars tensa. See the image below. Mirror display of a tympanic membrane surface on the polymeric masc from external acoustical canal of healthy man. Masc of tympanic membrane surface (MtmS). View Media Gallery The physiologic function of the TM involves conduction of sound to the middle ear through a system of small bones, the ossicles. The surface of the TM is approximately 25 times larger than that of the stapes footplate, with the resulting amplification of sound to 45 decibels, or 27 times ambient volume levels. At the same time, the TM forms a safe shield with the round window of the labyrinth against direct sound waves. This window is necessary for movement of the liquid in the cochlea, providing for transmission of the sound to the acoustic receptors in the organ of Corti. In addition, the TM protects the gentle mucosa of the middle ear from the external environment.

Next: Pathophysiology Regarding diseases of the TM, discussion of pathophysiology includes the concrete causes, mechanisms, and common regularities of source, development, and termination of myringitis. Myringitises can develop as self-maintained primary disease of the TM (primary myringitis) or as an effect of an inflammatory process of adjacent tissues of the external or middle ear (secondary myringitis). The etiology and pathogenesis of primary myringitis and secondary myringitis are significantly different, and they require different treatments. Therefore, they should be considered separately. Etiology of primary myringitis See the list below: Acute myringitis can occur because of direct trauma to the TM through penetration by a foreign body. Primary myringitis may also be caused by unsuccessful removal of a foreign body, such as a live insect, or it may occur during self-cleaning of the ear. An explosion, a change in the pressure in an airplane cabin, a blow to the ear with the palm, or even a kiss in the ear can cause trauma to the TM.

Acute bullous myringitis can be the consequence of a bacterial infection such as Streptococcus pneumoniae or a viral infection such as influenza, herpes zoster, and others. Acute hemorrhagic myringitis can also be the consequence of a bacterial or a viral infection. [ 1 ] Fungal myringitis can be the consequence of a fungal infection of the TM's epidermis. Eczematous myringitis can occur in cases of dermal eczema of the TM's epidermis. Myringitis granulosa occurs when the TM is covered with granulation tissue. The causes of this destruction of the TM's epidermis are rarely clear, except when a similar case is demonstrated during a myringoplasty, when the epidermis perishes, or when the mucosa, expanding from a tympanic membrane perforation , erases an epidermis. Etiology of secondary myringitis See the list below: Acute myringitis with acute otitis media The TM is involved in the initial stage of acute otitis media (AOM), the stage when negative pressure is formed in the middle ear space.

During this time, the handle of the malleus, the lateral process of the malleus, and the TM bulge outward. The pars flaccida is also noticeably affected. With the appearance of fluid in the middle ear, these phenomena disappear from the surface of the TM, so observing the fluid is possible. The inflammatory process of an upper respiratory tract infection affects the TM in the form of myringitis. The TM becomes red and thickened, and the light reflex disappears. Increased inflammation in the middle ear results in bulging of the TM with possible perforation. This is accompanied by intense earache and by typical clinical manifestations of AOM. Acute myringitis with acute otitis externa Acute myringitis can occur in cases of posttraumatic acute otitis externa. Myringitis can be the consequence of bacterial acute otitis externa. Myringitis can also be the consequence of viral acute otitis externa. Fungal myringitis can occur in cases of fungal otitis externa. Eczematous myringitis can occur in cases of dermal eczema of the external acoustic canal. Acute myringitis can occur in cases of an exacerbation of chronic inflammation of the EAC.

See also Middle Ear, Acute Otitis Media, Surgical Treatment and Middle Ear, Acute Otitis Media, Medical Treatment . Perforation of the tympanic membrane In untreated patients, as middle ear pressure increases, the TM eventually perforates, pain decreases, and mucopurulent discharge with blood appears in the EAC. In cases of favorable cessation of AOM, the inflammatory process and all the inflammatory phenomena gradually regress with restoration of the TM and normal hearing. Similar phenomena occur in cases of viral myringitis (influenza). With viral myringitis, as with acute bullous myringitis, bubbles filled with blood form on the surface of the TM and burst with effusing blood; however, the TM is not perforated. Chronic myringitis with chronic otitis media In cases of adverse courses of the inflammatory process, perforation of the TM persists. Persisting perforation is one characteristic sign of chronic otitis media (COM). Chronic inflammation of the TM accompanies inflammation of the middle ear. On the surface of the TM, the epidermis is actively displaced into the ear canal, and, in 15% of cases, it may penetrate through small perforations of the TM.

As a result, the middle ear is isolated, with resulting long-term hearing impairment. This takes place in cases in which the speed of mucosal displacement and that of epidermal displacement coincide. If perforation of the TM is considerable, the epidermis and the mucous membrane meet on the edge of the perforation. Some evidence exists that chronic otitis media may be related to extra-esophageal reflux. [ 2 ] Mucoepidermal conflict If the speed of the epidermis displacement and that of the mucosal displacement are different, conflict, which is typical for chronic myringitis, develops. When the redundant mucous membrane penetrates the perforation and extends over the edges of the dermis, growth of the epithelium ceases. The maceration of the dermis and its tendency to grow into the injured tissue become the main sources of inflammation. Lacking the necessary support, the mucous membrane forms granulation tissue and polyps. When redundant tissue has formed within the middle ear mucosa, the epidermis penetrates into the middle ear space through the edge of the perforated TM and expands there; it is exposed to desquamation, and cholesteatoma is formed.

All types of dermatitis of the external ear affect the TM, involving it in similar inflammation. Chronic myringitis with chronic otitis externa Chronic myringitis is often accompanied by chronic bacterial inflammation of the EAC. Chronic myringitis can also be the consequence of viral chronic otitis externa. Chronic fungal myringitis can occur in cases of chronic fungal otitis externa. Chronic eczematous myringitis can occur in cases of chronic dermal eczema of the external acoustic canal. Frequency United States Approximately 8% of children age 6 months to 12 years with AOM have acute bullous myringitis. Mortality/Morbidity Morbidity from myringitis is correlated with morbidity in cases of otitis media, external otitis, and foreign bodies in the ear. Race Data on racial distributions of TM diseases have not been collected. See also Middle Ear, Otitis Media with Effusion . Sex Males and females are affected by diseases of the TM with equal frequency. Age People of all ages are affected. Previous References Elzir L, Saliba I. Bullous hemorrhagic myringitis. Otolaryngol Head Neck Surg.

2013 Feb. 148 (2):347-8. [Medline] . Crapko M, Kerschner JE, Syring M, Johnston N. Role of extra-esophageal reflux in chronic otitis media with effusion. Laryngoscope. 2007 Aug. 117(8):1419-23. [Medline] . Crowson MG, Callahan K, Saunders JE. Review of otorrhea microbiology: is there a pathogenic role of corynebacter?. Otol Neurotol. 2015 Feb. 36(2):244-9. [Medline] . Rezes S, Késmárki K, Sipka S, Sziklai I. Characterization of otitis media with effusion based on the ratio of albumin and immunoglobulin G concentrations in the effusion. Otol Neurotol. 2007 Aug. 28(5):663-7. [Medline] . Barclay L. Postop Tympanostomy Tube Obstruction Common. Medscape Medical News. Jul 11 2014.

[Full Text] . Conrad DE, Levi JR, Theroux ZA, et al. Risk Factors Associated With Postoperative Tympanostomy Tube Obstruction. JAMA Otolaryngol Head Neck Surg. 2014 Jul 10. [Medline] . Phillips JS, Yung MW, Nunney I. Myringoplasty outcomes in the UK. J Laryngol Otol. 2015 Sep. 129 (9):860-4. [Medline] . Arnold DJ, Bressler KL. Permeability of tympanotomy tubes to ototopical preparations. Otolaryngol Head Neck Surg. 1999 Jul. 121(1):35-7. [Medline] . Blevins NH, Karmody CS. Chronic myringitis: prevalence, presentation, and natural history. Otol Neurotol. 2001. Jan;22(1):3-10. [Medline] . Casselbrant ML, Mandel EM, Rockette HE, Kurs-Lasky M, Fall PA, Bluestone CD.

Adenoidectomy for otitis media with effusion in 2-3-year-old children. Int J Pediatr Otorhinolaryngol. 2009 Oct 9. [Medline] . [Full Text] . Cox L, Macdonald CB. Further Study of the Acoustic Otoscope. Otolaryngology HNS. 1998. 119(2):160. Dawes PJ, Bingham BJ, Rhys R. Aspirating middle ear effusions when inserting ventilation tubes: does it influence post-operative otorrhoea, tube obstruction or the development of tympanosclerosis?. Clin Otolaryngol. 1991 Oct. 16(5):457-61. [Medline] . Franklin DJ, Starke JR, Brady MT, et al. Chronic otitis media after tympanostomy tube placement caused by Mycobacterium abscessus: a new clinical entity?. Am J Otol. 1994 May. 15(3):313-20. [Medline] .

Hoshino T, Yano J, Ichimura K, Hashimoto H, Nozue M. Chronic myringitis and chronic suppurative otitis media. Arch Otorhinolaryngol. 1982. 234(3):219-23. [Medline] . Jaisinghani VJ, Hunter LL, Li Y, Margolis RH. Quantitative analysis of tympanic membrane disease using video-otoscopy. Laryngoscope. 2000. Oct;110(10 Pt 1):1726-30. [Medline] . Jones WS, Kaleida PH. How helpful is pneumatic otoscopy in improving diagnostic accuracy?. Pediatrics. 2003. Sep;112(3 Pt 1):510-3. [Medline] . Jung HH, Cho SD, Yoo CK, Lim HH, Chae SW. Vinegar treatment in the management of granular myringitis. J Laryngol Otol. 2002. Mar;116(3):176-80. [Medline] .

Kotikoski MJ, Palmu AA, Nokso-Koivisto J, Kleemola M. Evaluation of the role of respiratory viruses in acute myringitis in children less than two years of age. Pediatr Infect Dis J. 2002. Jul;21(7):636-41. [Medline] . Kotikoski MJ, Palmu AA, Puhakka HJ. The symptoms and clinical course of acute bullous myringitis in children less than two years of age. Int J Pediatr Otorhinolaryngol. 2003. Feb;67(2):165-72. [Medline] . Li Y, Hunter LL, Margolis RH. Prospective study of tympanic membrane retraction, hearing loss, and multifrequency tympanometry. Otolaryngol Head Neck Surg. 1999 Nov. 121(5):514-22. [Medline] . Ott PM. [The red tympanic membrane] Schweiz Rundsch Med Prax. Review. German. 2004.

Oct 13;93(42):1733-7. [Medline] . Palmu AA, Kotikoski MJ, Kaijalainen TH, Puhakka HJ. Bacterial etiology of acute myringitis in children less than two years of age. Pediatr Infect Dis J. 2001. Jun;20(6):607-11. [Medline] . Pichichero ME, Poole MD. Assessing diagnostic accuracy and tympanocentesis skills in the management of otitis media. Arch Pediatr Adolesc Med. 2001. Oct;155(10):1137-42. [Medline] . Ramsay HA, Heikkonen EJ, Laurila PK. Effect of epidermal growth factor on tympanic membranes with chronic perforations: a clinical trial. Otolaryngol Head Neck Surg. 1995 Oct. 113(4):375-9. [Medline] . Romain O. Pneumatic otoscopy in pediatrics. Arch Pediatr. 2002.

Jun;9(6):644-5. French. [Medline] . Schilder AG, Zielhuis GA, Haggard MP. Long-term effects of otitis media with effusion: otomicroscopic findings. Am J Otol. 1995 May. 16(3):365-72. [Medline] . Uliyanov YP. Method of reception impression of meatus acusticus externus and prints of a membrana tympani. Bulletin of Russian Inventions and Discoveries USSR. 1965. 19:Patent: 175173. van Staaij BK, Rovers MM, Schilder AG, Hoes AW. Accuracy and feasibility of daily infrared tympanic membrane temperature measurements in the identification of fever in children. Int J Pediatr Otorhinolaryngol. 2003. Oct;67(10):1091-7. [Medline] . Weymuller EA Jr. Contemporary antimicrobial therapy. In: Gluckman JL. Renewal of Certification Study Guide in Otolaryngology HNS.

1998:38-45. Wielgosz R, Fronz Th, Lamprecht J. The Heermann-technique of cartilage palisade tympanoplasty. Long-term results from more than 15,300 operated clinical cases. XYI World Congress of Otorhinolaryngology HNS. 1997. 2:1085-8. Yinglin Z. Three cases of chronic granular myringitis cured by formalin. J Otolaryngol. 1985 Dec. 14(6):379-80. [Medline] . Media Gallery Tympanic membrane (TM) as continuation of the upper wall of external auditory canal (EAC) with angle of incline up to 45 degrees on the border between middle ear and the EAC. Normal tympanic membrane. Pars tensa (PT), pars flaccida (PF), light reflex (LR), fibrous ring (FR), umbo (Um), handle of malleus (HM), lateral process of malleus (Lpm), anterior plica (AP), posterior plica (PP).

Mirror display of a tympanic membrane surface on the polymeric masc from external acoustical canal of healthy man. Masc of tympanic membrane surface (MtmS). of 3 Determinants of hearing loss in perforations of the tympanic membrane. - PubMed - NCBI Determinants of hearing loss in perforations of the tympanic membrane. 1Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts 02114, USA. Abstract BACKGROUND: Although tympanic membrane perforations are common, there have been few systematic studies of the structural features determining the magnitude of the resulting conductive hearing loss. Our recent experimental and modeling studies predicted that the conductive hearing loss will increase with increasing perforation size, be independent of perforation location (contrary to popular otologic belief), and increase with decreasing size of the middle-ear and mastoid air space (an idea new to otology). OBJECTIVE: To test our predictions regarding determinants of conductive hearing loss in tympanic membrane perforations against clinical data gathered from patients. STUDY DESIGN: Patients with tympanic membrane perforations without other middle-ear disease.

MAIN OUTCOME MEASURES: Size and location of perforation; air-bone gap at 250, 500, 1,000, 2,000, and 4,000 Hz; and tympanometric estimate of volume of the middle-ear air spaces. RESULTS: Isolated tympanic membrane perforations in 62 ears from 56 patients met inclusion criteria. Air-bone gaps were largest at the lower frequencies and decreased as frequency increased. Air-bone gaps increased with perforation size at each frequency. Ears with small middle-ear volumes, < or = 4.3 ml (n = 23), had significantly larger air-bone gaps than ears with large middle-ear volumes, > 4.3 ml (n = 39), except at 2,000 Hz. The mean air-bone gaps in ears with small volumes were 10 to 20 dB larger than in ears with large volumes.

Perforations in anterior versus posterior quadrants showed no significant differences in air-bone gaps at any frequency, although anterior perforations had, on average, air-bone gaps that were smaller by 1 to 8 dB at lower frequencies. CONCLUSION: The conductive hearing loss resulting from a tympanic membrane perforation is frequency-dependent, with the largest losses occurring at the lowest sound frequencies; increases as size of the perforation increases; varies inversely with volume of the middle-ear and mastoid air space (losses are larger in ears with small volumes); and does not vary appreciably with location of the perforation. Effects of location, if any, are small. PMID: Images from this publication. See all images (7) Free text FIG. 1 Tympanograms illustrating the estimation of middle-ear volume in an ear with a TM perforation. (Above) Tympanometric tracing from the normal (contralateral) ear. The ear-canal volume is 1.4 ml, measured at −400 daPa of ear canal pressure. (Below) A flat tracing in the ear with the perforation, with a total volume of 7 ml.

Therefore, middle-ear volume in the ear with the perforation is estimated to be total volume in ear with perforation (7 ml) –ear-canal volume in contralateral normal ear (1.4 ml) = 5.6 ml. Otol Neurotol. ;27(2):136-143. FIG. 2 Scatterplot showing middle-ear volumes and areas of each perforation in the study population of 62 ears. Each ear is also grouped by location of the perforation: anterior, posterior, or both. Otol Neurotol. ;27(2):136-143. FIG. 3 Mean ABGs for the large-volume group (n = 39) and the small-volume group (n = 23) at each audiometric frequency. Error bars indicate ±1 standard error of the mean. Ears with small volumes had significantly larger ABGs at all frequencies except 2,000 Hz. Otol Neurotol. ;27(2):136-143. FIG. 4 Effects of area of perforation in the large volume group. Areas of perforations are in square millimeters.

Error bars indicate ± 1 standard error of the mean. Otol Neurotol. ;27(2):136-143. FIG. 5 ABGs (in decibels) at each audiometric frequency for anterior versus posterior TM perforations. All ears had a large middle-ear volume, >4.3 ml. The last column indicates a four-tone (500, 1,000, 2,000, and 4,000 Hz) pure-tone average. Perforation sizes were similar in both groups. Error bars indicate ±1 standard error of the mean. NS, not statistically significant at the 5% level (p > 0.05). Otol Neurotol. ;27(2):136-143. FIG. 6 Predicted versus measured ABGs at 250 and 500 Hz (n = 62 ears). The solid lines indicate a slope of 1 (measured = predicted). The dotted lines represent a best-fit linear regression line through the data points. The correlation coefficient (r) was highly significant (p < 0.01) for both frequencies. Otol Neurotol.

;27(2):136-143. FIG. 7 Illustrative clinical cases from the present study comparing the ABGs in perforations with substantially different middle-ear volumes. The differences in hearing losses in these cases can be readily understood on the basis of differences in middle-ear volume rather than location. Ears with smaller volumes demonstrate larger ABGs. (A) An anterior and a posterior TM perforation are shown, with differing middle-ear volumes. The solid line representing a 9.6-mm2 posterior perforation with a greater than or equal to 5.9 ml middle-ear volume has smaller ABGs of 0 to 40 dB. The dashed line is a 3.1-mm2 anterior perforation with a 1.2-ml middle-ear volume and has larger ABGs of 15 to 35 dB. The differences in hearing losses between these two ears can be best explained on the basis of their differing volumes. (B) An anterior and a posterior TM perforation are shown, with differing middle-ear volumes.

The solid line representing a 19.6-mm2 posterior perforation and a 0.9-ml middle-ear volume has large ABGs of 25 to 45 dB. The dashed line is an 11-mm2 anterior perforation with a greater than or equal to 5.7 ml volume and demonstrates smaller ABGs of 0 to 30 dB. The Normal Ear The Normal Ear Share Page Content The human ear can be divided into three sections: (1) the outer ear, (2) the middle ear, and (3) the inner ear. Each section has a different role in transmitting sound waves to the brain. View the diagrams below to learn more about the different sections of the ear and how we hear. Parts of the Outer Ear The outer ear consists of the visible portion on the side of the head, known as the pinna (1), and the external auditory canal or ear canal (2). The purpose of the pinna is to catch sound waves, amplify them slightly, and funnel them down the ear canal to the tympanic membrane or eardrum (3).

Parts of the Middle Ear The middle ear is an air-filled cavity that sits between the tympanic membrane (3) and the inner ear. The middle ear consists of the tympanic membrane (3), three tiny bones called ossicles (4), the round window (5), the oval window (6), and the Eustachian tube (7). The tympanic membrane is a very thin structure that separates the external ear canal from the middle ear space. The first ossicle, called the malleus (commonly known as the hammer) is attached to the tympanic membrane. The other end of the malleus is attached to the second ossicle, called the incus (anvil). The incus, in turn, is attached to the third ossicle, called the stapes (stirrup). The base of the stapes (footplate) is located in a depression called the oval window (6). The oval window membrane is one of two membranes that separate the middle ear space from the inner ear. The other is the round window membrane. The Eustachian tube (7) connects the middle ear space to the upper part of the throat.

In its normal state, the Eustachian tube stays closed, but it will open when you yawn, swallow, chew, or hold your nose and blow. The purpose of the Eustachian tube is to provide fresh air to the middle ear space and to equalize pressure between the outer ear and the middle ear. Ever wonder why your ears “pop” when you go up or down in an airplane or an elevator in a tall building? That sound is your Eustachian tube(s) opening and closing to equalize the air pressure in your ears. Parts of the Inner Ear The inner ear is encased in the temporal bone (8). The inner ear consists of three parts: the vestibule (9), the cochlea (10), and the semicircular canals (11). The vestibule is the central inner ear cavity, the cochlea is the organ of hearing, and the semicircular canals are part of the balance system. The cochlea is made up of three compartments (scala tympani, scala media, scala vestibuli) that are separated from each other by two membranes (basilar membrane and Reissner’s membrane).

A tiny organ (organ of Corti) sits on top of the basilar membrane. This organ contains hair cells, which convert the mechanical energy from the vibrations of the basilar membrane into electrical impulses. Those electrical impulses are sent to the auditory nerve (12), which transmits the information up the brainstem to the auditory cortex. How We Hear The pinna catches sound waves and channels them down the external auditory canal, where they hit the tympanic membrane and make it vibrate. Those vibrations cause the three ossicles to move. The stapes footplate pushes on the oval window membrane, which sets the cochlear fluid in motion. This wave-like motion causes the basilar membrane to vibrate. As the basilar membrane moves up and down, the tiny “hairs” (stereocilia) on top of the hair cells open and close to change the electrical charge of the cell. This results in a release of chemicals (neurotransmitter), which signals auditory nerve fibers to fire. The auditory nerve sends these impulses up to the brain, where the signal is interpreted as sound. Normal Hearing - Video clip courtesy of Cochlear Corporation.

Ear Institute of Chicago--Ear Surgery--Tympanoplasty Tympanoplasty: Repair of Ear Drum Perforations Definition: Tympanoplasty means to fix ("plasty") the ear drum ("tympanic"). Ear Drum (Tympanic Membrane) Anatomy The ear drum (also known as the tympanic membrane) is an oval shaped structure, with an average size of 8 x 10 millimeters, and is composed of three layers. The outer layer consists of a thin layer of skin, the middle layer is made of fibrous tissue and the inner layer is mucosa (similar to the tissue in the mouth and nose). The tympanic membrane is secured to the sidewalls of the end of the outer ear canal by a thick band of tissue called the tympanic ring or annulus. This ring helps in the overall structural integrity and stability of the eardrum. The integrity of the tympanic membrane and associated structures is important for proper sound conduction. The following is a list of the more common causes for tympanic membrane perforations: Infection Blunt (e.g. slapping the ear with an open hand) Penetrating (e.g.

inserting a Q-tip too far into the ear canal) Barotrauma (sudden changes in air pressure; e.g. after scuba diving Tympanic membrane perforations may heal spontaneously, but this depends largely on two factors: the size of the perforation (perforations greater than 40 – 50% of the tympanic membrane rarely heal by themselves, regardless of the cause) and the presence of infection (“wet” or infected perforations rarely close spontaneously). Of the causes listed above, perforations from blunt trauma are the most likely to heal spontaneously. The rate of spontaneous closure (meaning: no treatment necessary) of tympanic membrane perforations from blunt trauma is approximately 80 – 85%. This closure rate is true only for perforations from blunt trauma that do not become infected. Preventing water from entering the ear canal helps to avoid infections in the ear. When the eardrum is unable to heal itself, the ear surgeon has techniques to close these perforations. Through the years, numerous materials have been used to close tympanic membrane perforations.

These materials have included paper, synthetic films, skin, vein, ear lobe fat, fascia (thin tissue that covers muscle) and perichondrium (thin tissue that wraps around cartilage). Fascia is, by far, the most common material used currently to repair tympanic membrane perforations. There are two basic techniques of closure of tympanic membrane perforations as defined below. Definitions of Tympanc Membrane Closure Techniques Myringoplasty Myringoplasty means surgery confined to the tympanic membrane itself. The middle ear bones (ossicles) are not touched and the tympanic membrane is not lifted from its position in the ear canal. Myringoplasty is most often performed in the office for small eardrum perforations. In brief, the technique consists of anesthetizing the margins of the tympanic membrane perforation with a drop of medicine while the surgeon views the ear under a microscope. The perforation is prepared for grafting by trimming the margins of the perforation to remove scar tissue at the edges of the perforation. Scar tissue prevents new tissue growth. After the perforation is prepared for grafting, a thin piece of paper impregnated with antibiotic ointment is placed over the perforation.

The tympanic membrane uses the paper graft as a scaffold over which a new eardrum can grow. Myringoplasty is effective in approximately 60% of cases in closing the tympanic membrane perforation. Tympanoplasty Tympanoplasty includes all procedures when the tympanic membrane is lifted from its position in the ear canal. Tympanoplasty is most commonly performed for tympanic membrane perforations greater than 10 – 20% of the size of the entire tympanic membrane. Tympanoplasty alone or type 1 tympanoplasty denotes that the surgery is confined to the eardrum alone, and no manipulation of the middle ear bones (ossicles) occurs. Tympanoplasty that includes manipulation of the ossicles is defined as tympanoplasty with ossicular reconstruction, or tympanoossiculoplasty. Surgery that includes manipulation of the mastoid bone behind the ear in any way is known as tympanoplasty with mastoidectomy (for more information regarding mastoidectomy, please click here) . Unless there are complicating factors, patients are discharged home the same day of surgery (outpatient procedure) for any type of tympanoplasty procedure.

Tympanoplasty is typically performed under general anesthesia. Overall, there is approximately 95 – 98% success rate in closing tympanic membrane perforations with tympanoplasty. There are two ways to approach the tympanic membrane perforation when performing tympanoplasty. These two approaches are known as the transcanal (through the ear canal) or the postauricular (behind the outer ear) approaches, described below. Transcanal Approach The transcanal (meaning, through the ear canal) approach is performed exclusively through the ear canal except for a small incision behind the ear, which is used to obtain the graft material. The transcanal approach is reserved for relatively small perforations located in the back (posterior) portion of the tympanic membrane. This is because the transcanal approach gives a limited or incomplete view of the front (anterior) portion of the eardrum. Postauricular Approach The postauricular (meaning, behind the outer ear) approach is the most common type of tympanoplasty approach performed by the surgeons of the Ear Institute of Chicago. With this approach, a curved incision is made immediately behind the crease of the outer ear (also called the auricle).

The postauricular approach gives an excellent view of the entire eardrum, unlike the transcanal approach. The terms transcanal and postauricular are approaches, or ways to get to the tympanic membrane perforation. Once the surgeon reaches the tympanic membrane perforation, he or she has two basic options or techniques of performing the tympanoplasty: the underlay or the overlay technique. For more information regarding the underlay and overlay techniques, please click the next button below. Copyright 2016 Cautery of the tympanic membrane: the lesser known history of myringoplasty. - PubMed - NCBI 1Department of Otolaryngology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK. matthewrbfarr@googlemail.com Abstract OBJECTIVE: To present the fascinating, controversial, and tumultuous history of tympanic cautery as a form of myringoplasty and describe the relevance of work more than 150 years old to modern practice and research. DATA SOURCES: More than 70 English, French, and German articles and books published over the last 400 years, which refer to some aspect of tympanic membrane cautery.

HISTORY: The first recorded use of silver nitrate to stimulate closure of tympanic membrane perforations is by William Wilde in 1848. Since then, numerous modifications of this technique have been used, and its significance has waxed and waned in response to events within the speciality of otology and the wider world. CONCLUSION: There are lessons to be learned from the rise and fall of this once widely practiced technique. There exists a school of thought that believes that the significance of cautery lies not only in the history of otology but also in its future. PMID:

Question: What is the tympanic membrane better known as?
Answer: Eardrum